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General NPI Number Information
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NPI Number | 1902059447
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Entity Type | Individual
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Provider Name | KIM I DE LA CRUZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1215 LEE ST STE 4077
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-3771
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Country | US
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Telephone | 434-924-9300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749112
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City | ATLANTA
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State | GA
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Zip | 30374-9112
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Country | US
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Telephone | 434-295-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 0101242365
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 292123
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | N0722
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 292123
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101242365
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N0722
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License Number State | TX
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